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Abstract Background The relative contributions of the cytotoxic phenotype of <it>P. aeruginosa </it>expressing type III secretory toxins and an immunocompromised condition lacking normal Toll-like receptor 4 (TLR4) signaling in the pathogenesis of acute lung injury and sepsis were evaluated in a mouse model for <it>Pseudomonas aeruginosa </it>pneumonia. By using lipopolysaccharide-resistant C3H/HeJ mice missing normal TLR4 signaling due to a mutation on the <it>tlr4 </it>gene, we evaluated how TLR4 signaling modulates the pneumonia caused by cytotoxic <it>P. aeruginosa </it>expressing type III secretory toxins. Methods We infected C3H/HeJ or C3H/FeJ mice with three different doses of either a cytotoxic <it>P. aeruginosa </it>strain (wild type PA103) or its non-cytotoxic isogenic mutant missing the type III secretory toxins (PA103Δ<it>UT</it>). Survival of the infected mice was evaluated, and the severity of acute lung injury quantified by measuring alveolar epithelial permeability as an index of acute epithelial injury and the water to dry weight ratios of lung homogenates as an index of lung edema. Bacteriological analysis and cytokine assays were performed in the infected mice. Results Development of acute lung injury and sepsis was observed in all mouse strains when the cytotoxic <it>P. aeruginosa </it>strain but not the non-cytotoxic strain was instilled in the airspaces of the mice. Only C3H/HeJ mice had severe bacteremia and high mortality when a low dose of the cytotoxic <it>P. aeruginosa </it>strain was instilled in their lungs. Conclusion The cytotoxic phenotype of <it>P. aeruginosa </it>is the critical factor causing acute lung injury and sepsis in infected hosts. When the <it>P. aeruginosa </it>is a cytotoxic strain, the TLR4 signaling system is essential to clear the batcteria to prevent lethal lung injury and bacteremia.</p

TLR4 signaling is essential for survival in acute lung injury induced by virulent Pseudomonas aeruginosa secreting type III secretory toxins